We tested the validity of the 48-Pictures Test,
a 2-alternative forced-choice recognition test, in detecting
exaggerated memory impairments. This test maximizes subjective
difficulty, through a large number of stimuli and shows
minimal objective difficulty. We compared 17 suspected
malingerers to 39 patients with memory impairments (6 amnesic,
15 frontal lobe dysfunctions, 18 other etiologies), and
17 normal adults instructed to simulate malingering on
three memory tests: the 48-Pictures Test, the Rey Auditory
Verbal Learning Test (RAVLT), and the Rey Complex Figure
Test (RCFT). On the 48-Pictures Test, the clinical groups
showed good recognition performance (amnesics: 85%; frontal
dysfunction: 94%; other memory impairments: 97%), whereas
the two simulator groups showed a poor performance (suspected
malingerers: 62% correct; volunteer simulators 68% correct).
The two other tests did not show a high degree of discrimination
between the clinical groups and the simulator groups, except
in 2 measures: the 2 simulator groups tended to show a
performance decrement from the last recall trial to immediate
recognition of the RAVLT and also performed better than
the clinical groups on the immediate recall of the RCFT.
A discriminant analysis with the latter 2 measures and
the 48-Pictures Test correctly classified 96% of the participants.
These results suggest that the 48-Pictures Test is a useful
tool for the detection of possible simulated memory impairment
and that when combined to the RAVLT recall–recognition
difference score and to the immediate recall score on the
RCFT can provide strong evidence of exaggerated memory
impairment. (JINS, 1997, 3, 545–552.)